Dataset Information

Primary care physicians' access to in-house ultrasound examinations across Europe: a questionnaire study.

ABSTRACT:

Objective

The overall objective of this study was to examine the differences in ultrasound availability in primary care across Europe.

Design

Cross-sectional study.

Setting

Primary care.

Participants

Primary care physicians (PCPs).

Primary and secondary outcomes measures

The primary aim was to describe the variation in in-house primary care ultrasonography availability across Europe using descriptive statistics. The secondary aim was to explore associations between in-house ultrasonography availability and the characteristics of PCPs and their clinics using a mixed-effects logistic regression model.

Results

We collected data from 20 European countries. A total of 2086 PCPs participated, varying from 59 to 446 PCPs per country. The median response rate per country was 24.8%. The median (minimum-maximum) percentage of PCPs across Europe with access to in-house abdominal ultrasonography was 15.3% (0.0%-98.1%) and 12.1% (0.0%-30.8%) had access to in-house pelvic ultrasonography with large variations between countries. We found associations between in-house abdominal ultrasonography availability and larger clinics (OR 2.5, 95% CI 1.2 to 4.9) and clinics with medical doctors specialised in areas, which traditionally use ultrasonography (OR 2.1, 95% CI 1.1 to 3.8). Corresponding associations were found between in-house pelvic ultrasonography availability and larger clinics (OR 1.9, 95% CI 1.3 to 2.7) and clinics with medical doctors specialised in areas, which traditionally use ultrasonography (OR 3.0, 95% CI 1.8 to 5.1). Additionally, we found a negative association between urban clinics and in-house pelvic ultrasound availability (OR 0.5, 95% CI 0.2 to 0.9).

Conclusions

Across Europe, there is a large variation in PCPs' access to in-house ultrasonography and organisational aspects of primary care seem to determine this variation. If evidence continues to support ultrasonography as a front-line point-of-care test, implementation strategies for increasing its availability in primary care are needed. Future research should focus on facilitators and barriers that may affect the implementation process.

SUBMITTER: Aakjær Andersen C

PROVIDER: S-EPMC6773286 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Primary care physicians' access to in-house ultrasound examinations across Europe: a questionnaire study.

Aakjær Andersen Camilla C Jensen Martin Bach B MBB Toftegaard Berit Skjødeberg BS Vedsted Peter P Harris Michael M Research Group Örenäs Ö

BMJ open 20190930 9

<h4>Objective</h4>The overall objective of this study was to examine the differences in ultrasound availability in primary care across Europe.<h4>Design</h4>Cross-sectional study.<h4>Setting</h4>Primary care.<h4>Participants</h4>Primary care physicians (PCPs).<h4>Primary and secondary outcomes measures</h4>The primary aim was to describe the variation in in-house primary care ultrasonography availability across Europe using descriptive statistics. The secondary aim was to explore associations be ...[more]

PMID: 31575576

Similar Datasets

Project description:Purpose:Point-of-care ultrasound (POCUS) is a quick bedside tool that has the potential to improve emergency care in resource?-limited settings due to its relatively low cost and accessibility. Effort to disseminate the knowledge and skills about POCUS is inadequate in low and middle income countries like Nepal. We conducted a two-day ?interdisciplinary ?advanced ?emergency ultrasound workshop that targeted physicians working in ?emergency ?department and ?primary care, especially in rural Nepal. We explored the effectiveness of this training based on validated Kirkpatrick's 4 steps of evaluating training outcomes. Materials and Methods:We conducted a prospective quasi-experimental study with mixed research design. Multidisciplinary physicians working in emergency departments participated in the two-day workshop. We assessed and compared the pre- and post-workshop knowledge. We collected on-site and a follow-up feedback to explore pre- and post?-workshop confidence level, perceived usefulness and clinical use of ultrasound using a 5?-point Likert scale. The barriers to use POCUS were explored. Results:A total of 50 physicians from different parts of Nepal participated in the workshop. The academic level of the participants, duration of their clinical experience and the previous use of POCUS did not have a significant difference in their pre- and posttest knowledge scores. The difference between the median (IQR) pre- and posttest scores [14 (12.75-17.75) and 24.5 (22.25-25.5), respectively] was statistically significant (p<0.001). Perceived confidence level and usefulness of the POCUS increased significantly in all of its domains (p<0.001). Self-reported increase in its clinical use was significant (p<0.001) for all fields. Conclusion:The participation in this emergency ultrasound workshop increased the knowledge of participants in POCUS. Their confidence, perceived usefulness and clinical use of POCUS improved significantly. Objective longitudinal follow-up of participants' skill and demonstration of increased clinical use of POCUS in ?emergency ?department influencing the clinical outcome would be the focus of future research.

Project description:BackgroundEarly identification of patients with reduced left ventricular ejection fraction (LVEF) could facilitate the care of patients with suspected heart failure (HF). We examined if (1) focused cardiac ultrasound (FCU) performed with a hand-held device (Vscan 1.2) could identify patients with LVEF < 50%, and (2) the distribution of HF types among patients with suspected HF seen at primary care clinics.MethodsFCU performed by general practitioners (GPs)/GP registrars after a training programme comprising 20 supervised FCU examinations were compared with the corresponding results from conventional cardiac ultrasound by specialists. The agreement between groups of estimated LVEF < 50%, after visual assessment of global left ventricular function, was compared. Types of HF were determined according to the outcomes from the reference examinations and serum levels of natriuretic peptides (NT-proBNP).ResultsOne hundred patients were examined by FCU that was performed by 1-4 independent examiners as well as by the reference method, contributing to 140 examinations (false positive rate, 19.0%; false negative rate, 52.6%; sensitivity, 47.4% [95% confidence interval [CI]: 27.3-68.3]; specificity, 81.0% [95% CI: 73.1-87.0]; Cohen's κ measure for agreement = 0.22 [95% CI: 0.03-0.40]). Among patients with false negative examinations, 1/7 had HF with LVEF < 40%, while the others had HF with LVEF 40-49% or did not meet the full criteria for HF. In patients with NT-proBNP > 125 ng/L and fulfilling the criteria for HF (68/94), HF with preserved LVEF (≥50%) predominated, followed by mid-range (40-49%) or reduced LVEF (< 40%) HF types (53.2, 11.7 and 7.4%, respectively).ConclusionsThere was poor agreement between expert examiners using standard ultrasound equipment and non-experts using a handheld ultrasound device to identify patients with reduced LVEF. Asides from possible shortcomings of the training programme, the poor performance of non-experts could be explained by their limited experience in identifying left ventricular dysfunction because of the low percentage of patients with HF and reduced ejection fraction seen in the primary care setting.Trial registrationThe study was registered at ClinicalTrials.gov (NCT02939157). Registered 19 October 2016.

Project description:BackgroundThe growing number of primary care physicians (PCPs) reducing their clinical work hours has raised concerns about meeting the future demand for services and fulfilling the continuity and access mandates for patient-centered care. However, the patient's experience of care with part-time physicians is relatively unknown, and may be mediated by continuity and access to care outcomes.ObjectiveWe aimed to examine the relationships between a physicians' clinical full-time equivalent (FTE), continuity of care, access to care, and patient satisfaction with the physician.DesignWe used a multi-level structural equation estimation, with continuity and access modeled as mediators, for a cross-section in 2010.ParticipantsThe study included family medicine (n?=?104) and internal medicine (n?=?101) physicians in a multi-specialty group practice, along with their patient satisfaction survey responses (n?=?12,688).Main measuresPhysician level FTE, continuity of care received by patients, continuity of care provided by physician, and a Press Ganey patient satisfaction with the physician score, on a 0-100 % scale, were measured. Access to care was measured as days to the third next-available appointment.Key resultsPhysician FTE was directly associated with better continuity of care received (0.172% per FTE, p?<?0.001), better continuity of care provided (0.108% per FTE, p?<?0.001), and better access to care (-0.033 days per FTE, p?<?0.01), but worse patient satisfaction scores (-0.080% per FTE, p?=?0.03). The continuity of care provided was a significant mediator (0.016% per FTE, p?<?0.01) of the relationship between FTE and patient satisfaction; but overall, reduced clinical work hours were associated with better patient satisfaction (-0.053 % per FTE, p?=?0.03).ConclusionsThese results suggest that PCPs who choose to work fewer clinical hours may have worse continuity and access, but they may provide a better patient experience. Physician workforce planning should consider these care attributes when considering the role of part-time PCPs in practice redesign efforts and initiatives to meet the demand for primary care services.

Dataset Information

Primary care physicians' access to in-house ultrasound examinations across Europe: a questionnaire study.

Objective

Design

Setting

Participants

Primary and secondary outcomes measures

Results

Conclusions

Publications

Primary care physicians' access to in-house ultrasound examinations across Europe: a questionnaire study.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure